Medicaid panel seeks "a Missouri solution'

A committee reviewing possible changes to Missouri's Medicaid system reconvened Tuesday to hear representatives from Michigan and Florida discuss how their states use managed care.

In a managed care system, a state makes agreements with health care companies to pay them on a monthly basis, making these providers known as managed care organizations (MCOs). Private insurance companies can offer Medicaid recipients health plan options in this model. Missouri uses managed care and fee-for-service systems, in which providers are paid per service, such as an office visit, procedure or test.

Northern and southern most counties in the state are fee-for-service. Cole and its surrounding counties are among more than 50 in the eastern, western and central regions that have used managed care since the mid-1990s. Missouri has three managed care organizations: Aetna Better Health of Missouri, Home State (Centene) and Missouri Care (Well Care). All states except Alaska, Wyoming and Connecticut have some form of managed care, said Dr. Vern Smith, former Michigan Medicaid director.

The Task Force for Examining Statewide Medicaid Delivery Models is reviewing options to determine what's most beneficial for recipients and cost effective for the entire state. The task force is made of House representatives, senators and health professionals from across Missouri.

In fiscal year 2014, Missouri appropriated more than $9.4 billion to Medicaid, and costs have risen more than $1.35 billion over the past three years.

Justin Senior, deputy secretary for Medicaid within the Florida Agency for Health Care Administration, opened discussions Tuesday with a presentation on his state, where there are 19 MCOs. Each region in the state has a different set of plan options while trying to "run one holistic approach," Senior said.

"It's incentivized to provide higher quality without causing health care inflation," he said.

Florida implemented its managed care system during 2013-14. Senior said recipients said they experienced "high satisfaction" with the system and the model had "good accountability measures." The Sunshine State has experienced a 5 percent cost savings per recipient per month since rolling out its managed care system.

Though Florida doesn't cover adult dental care, Senior said, every MCO plan has some form of preventative dentistry. Health providers knew including this service would save them money because patients would be in the emergency room less for oral issues. Missouri's Medicaid system currently covers pediatric oral care, but not adult.

"If you don't pay for adult dental or some part of adult dental, you're still going to be paying for emergency room services for dental crisis," Senior said.

Smith, who presented on trends in Medicaid policy, said coordinated care initiatives account for 35-40 percent of Medicaid spending, and those efforts improve care and reduce costs. One-third of states with MCOs, Smith said, have some sort of long-term managed care arrangement. He said population health and social determinants of health have been priority topics among states.

"This is something completely new," Smith said. "Usually, we've focused on what Medicaid can do in terms of health care eligibility and focused on costs of that ... but now the discussions have turned toward outcomes in terms of what Medicaid is doing and what Medicaid is doing for the health of the entire community."

Changing Missouri's Medicaid model will take resources and time, he said, but "they're worth it because we're talking about serving people better ... and saving costs." Smith also advised the task force to assess the state's unique needs and develop a system reflecting that.

"What you have to do in Missouri has to be a Missouri solution," he said. "There is not one way."

Missouri is one of 20 states that have not yet expanded Medicaid, and the state's federal poverty level rate for eligibility is one of the lowest in the country at 19 percent.